Anterior Cervical Discectomy with Fusion (ACDF)

Anterior cervical discectomy and fusion (ACDF) is a surgical procedure used in the management of spinal cord and nerve root compression secondary to certain disorders such as degenerative disc disease, herniated disc, spondylosis, and spinal stenosis. ACDF reduces the neck and arm pain and provides stability to the spine.

Term

Meaning

Anterior

Front of the body

Cervical

Neck

Discectomy

Surgical removal of an intervertebral disc

Fusion

Join (fuse) 2 or more vertebral bodies

Before the surgery, the neurosurgeon explains the details of the procedure to the patient including the possible risks and complications such as infection, bleeding, nerve damage and reaction to anesthesia.

A minimally invasive approach may be employed in some individuals depending on their diagnosis, medical history, earlier treatments and other factors.

A general health clearance from a general physician is essential for the surgery. This assessment may comprise of blood tests, X-rays or other imaging studies, along with special tests for the diagnosis of other medical problems such as diabetes and cardiac disease.

Procedure

Anterior cervical discectomy and fusion is performed under general anesthesia. During the surgery, different gauges, monitors, and equipment are employed, which provides the visual and audio feedback to the surgeon. All the vital functions, including central nervous system are carefully monitored throughout the procedure. Image guidance such as real-time x-ray or fluoroscopy helps the neurosurgeon to visualize the surgical field during the surgery. The essential steps involved in minimally invasive ACDF are as follows:

The patient is placed on a padded operation table, facing up

The cervical level of the patient is confirmed by real time X-ray

An incision is made in front of the neck through one of the natural folds to disguise scarring

Then muscle and other soft tissues are pulled aside to expose the intervertebral disc

A discectomy is carried out to remove the entire disc or a portion of it

A block of bone or cage (s) is placed in the disc space. A bone graft may be used to fill this space

Bone Graft Type

What It Is

Autograft

Bone from your body

Allograft

Donor bone

The spinal cord and nerve roots are further decompressed by removing the bony outgrowths such as bone spurs, osteophytes, and thickened ligament or other tissues

The space between the upper and lower vertebral bodies is restored. This helps in decompression of the neural structures by enlarging the normal pathway of the nerve.

Extra bone graft is filled around the disc space.

The anterior portion of the spine is fixed with a cervical plate using bone screws to stabilize the neck.

Finally, the incision is sutured and dressed.

Post-Operative Care

After the surgery the patient is brought to the recovery area, where the medical staff monitors the vitals and also manages post-operative pain. Patients may experience pain at the site of incision, spasms of the neck muscles, or other symptoms. After the surgery, a cervical brace is placed on the neck of the patient.

Some of the common post-spine surgery instructions which the patient needs to remember are as follows:

Schedule a follow-up appointment

The incision should be kept clean and dry

While taking a shower the incision should be covered

Wear the cervical brace as instructed

Avoid tub baths, but can go for swimming, or sit in a hot tub or pool

Take rest as it helps rapid healing

Start physical therapy and exercises as per the instructions of the surgeon

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